The EU is becoming a retirement home (anglický originál článku pro European Voice)
||Politicians should not delay cost
control reforms to cope with an
ageing population just because
they are unpopular, argues Zuzana Roithova.
‘The EU is becoming a
retirement home. The number
of seniors is increasing and
the proportion of working
|[ 12. dubna 2005 | Autor: ]|
Europe is getting old. In the last
100 years, life expectancy has
grown from 55 to 80 years. At
the same time fewer children are being
born so that in 2030 the population of
the old continent will start to die out.
Longer life expectancy reflects both a
higher standard of living, which has led
to great reductions in infectious deseases,
and developments in medicine. Most
diseases are not terminal as they
In some countries the population
decrease can be slowed by immigration or
by higher birth-rates among immigrant
groups. But taken as a whole, an ageing
population together with increased
expectations of health services will bring
to Europe social and cultural changes,
great changes in health and social
services system as well as, for example,
in town planning and public transport.
The EU is becoming a retirement
home. The number of seniors is
increasing and the proportion of working
people – those who are creating
financial resources for the more
and more expensive healthcare
– is decreasing. In the Czech Republic,
r e t i r e m e n t – a g e d
people consume 80% of health costs.
This is the result of medical success rather than failure.
Although the genetical predetermination of maximal life expectancy is 100 to 110 years because ageing has its biological limits, I
am convinced that this trend is only
approaching its peak. Politicians should
not postpone the necessary cost control
reforms even though they are not popular.
The medical possibilities and citizens‘
desire for quality health and social services
are rising faster than the financial facilities
of a European society based on a
solidarity principle. Public funds are
created by those who are now healthy and
rich, they contribute to the ill and poor.
The degree of intergenerational
solidarity is more distinct in the postcommunist
countries than in the EU-15
and that is why the financial contrast is
more obvious and getting into crisis there.
It is displayed as hospital indebtedness,
reduced investment in modernisation,
lower salaries for medical workers and
long waiting lists.
The need for reform is strongest in the
new member states. A high degree of
solidarity is part of our Christian values on
which we have built our common
European house. But boundless solidarity
leads to abuse and to common poverty.
Experiences from socialist times in the
new member countries vouch that this is
not just a theory but fact. In those times
the state was more responsible for health
than people themselves. Services were for
free and patients could not influence the
price of services or the quality. Patients
did not even know the price and used to
visit doctors even with banal problems.
This attitude survives even today when
the treatment is financed from the public
insurance. But attempts at reform are
problematic because they are unpopular.
To be effective they have to make
the patient more complicit in deciding
on treatment or prevention. Patients must be involved in the system
as consumers of services, knowing their
rights and duties, able to take
part in controlling quality
and costs. But they must have enough
c o m p r e h e n s i b l e information. However it
takes time and requires a political vision to change the patients’/voters’ ways
of thinking. The new member states are closer to this vision because
they are under greater economic pressure.
Their experiences – the good and the bad
ones – are a benefit for the rest of Europe.
In addition to cost control, the
objective of outside health care quality
control is the most important element of
medical reforms. More and more
hospitals are subjecting themselves to
voluntary national or international
accreditation. Increasing patient mobility
brings the necessity of raising confidence
among patients and insurance
companies in the quality and safety of
services, disregarding state borders.
Although national systems are
different, the basic principles are similar
and possible solutions are similar: cost
control, greater concern for the quality
of health and social care. The recent
EU enlargement is an opportunity to
solve it together and to multiply forces
for reforming health and social care.